Podiatry
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Item Prediction of stump healing in lower limb amputation: A narrative review(Mark Allen Group, 2019-12-11) Ashraff, Suhel; Siddiqui, Muhammad A.; Santos, Derek; Carline, TomBoth types of diabetes, as well as different forms of acquired diabetes, are associated with diabetic peripheral neuropathy. Diabetic foot ulcers (DFU) is the condition most commonly related to somatic peripheral neuropathy, often leading to gangrene and limb amputation. Independent from large-vessel disease, sensory loss may result in DFU development and even amputation. The crucial part of any lower limb amputation is the stump healing process, which represents the central goal of postoperative management. Despite the importance attributed to this process, a standard set of guidelines regarding efficient healing methods is yet to be formulated. Health professionals are faced with the challenge of assessing the different risk factors and deciding which has a greater influence on the stump healing rate. There is currently an insufficient number of studies regarding factors effecting lower limb amputation. The main purpose of this review is to discuss the markers that can be helpful in the prediction of stump healing in patients who have undergone lower limb amputation.Item Predictive parameters of arteriovenous fistula maturation in patients with end-stage renal disease(Korean Society of Nephrology, 2018-09-30) Siddiqui, Muhammad A.; Ashraff, Suhel; Santos, Derek; Rush, Robert; Carline, Tom; Raza, ZahidBackground:The objevctive of the present study was to explore the potential influence of blood markers and patient factors such as risk factors, kidney function profile, coagulation profile, lipid profile, body mass index, blood pressure, and vein diameter on the maturation of arteriovenous fistula (AVF) in patients with end-stage renal disease. Methods:Retrospective data from 300 patients who had undergone AVF creation at the Royal Infirmary of Edinburgh were examined. A predictive logistic regression model was developed using a backward stepwise procedure. Model performance, discrimination, and calibration were assessed using the receiver operating characteristic (ROC) curve and Hosmer-Lemeshow goodness-of-fit test. The final model was externally validated by 100 prospective patients who received a new fistula at the Royal Infirmary of Edinburgh. Results:A total of 400 (300 retrospective and 100 prospective) patients were recruited for this study, with a mean age of 60.14 ± 15.9 years (development set) and 58 ± 15 years (validation set), respectively (P = 0.208). Study results showed that males were twice as likely to undergo fistula maturation as females, while patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula and a preoperative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation as compared with a vein size of less than 2.5 mm. The model for fistula maturation had fair discrimination, as indicated by the area under the ROC curve (0.68), but good calibration as indicated by the Hosmer-Lemeshow test (P = 0.79). The area under the receiver operating curve for the validation model in the validation set was 0.59. Similarly, in the validation set, the Hosmer-Lemeshow statistic indicated an agreement between the observed and predicted probabilities of maturation (P > 0.05). Conclusion:Gender, PVD, and vein size are independent predictors of AVF maturation. The clinical utility of these risk categories in the maturation of AVF requires further evaluation in longer follow-up.Item Complications of Stump Healing Among Diabetic Population(Society of Endocrinology and Metabolism of Turkey, 2018-06-19) Ashraff, Suhel; Siddiqui, Muhammad A.; Santos, Derek; Carline, TomLower limb amputation is a major procedure performed in diabetic patients with multiple comorbidities. Almost 10% of the National Health Service budget is taken up by diabetes, with diabetes-related complications accounting for 80% of the costs. The process of wound healing is complex and involves regenerating the cellular organization and the tissue layers. Diabetics are five times more predisposed to wound infection than patients without diabetes mellitus. The amputated stump frequently becomes infected due to inadequate blood circulation, a weak immune system, and poorly controlled diabetes mellitus. Pain, stump edema, and osteomyelitis are significant complications associated with lower limb amputation wounds. A number of factors may substantiate the need for re-amputation, such as stump pain and/or phantom limb pain, delayed stump infection, the formation of symptomatic bone spurs, assessment of the skin flap designed to preserve stump length, and preparation of the stump for the prosthetic device. There are currently no reliable standards that can be referred to prior to leg amputation. The clinicians, therefore, have to rely on their judgment and investigatory parameters. The main purpose of this review is to discuss the difficulties of stump healing in the diabetic population.Item Comparison of Siriraj Stroke Score with Computerized Tomography in Establishing the Type of the Stroke among Pakistani Population(2015-09) Jamal, Q.; Rahman, A. S.; Razzaque, S.; Siddiqui, Muhammad A.; Ara, J.; Altaf, A.Computed Tomography (CT) Scan is an accurate and a routinely done imaging technique to diagnose and differentiate haemorrhagic and ischaemic stroke. Siriraj Stroke Score (SSS) is weighted clinical score and European recognized for clinical and bedside differentiation between ischemic and haemorrhagic stroke. This study aimed to establish the accuracy of SSS in the bedside diagnosis of cerebral haemorrhage in comparison with CT scan to avoid delay in treatment. Total 152 patients were included in the study. Out of which 39.5% were male. Overall, mean age was 59.2811.91, 56.32 12.69 in haemorrhagic group and 62.3210.28 in non-haemorrhagic group. Sensitivity, specificity, PPV, and NPV of SSS for haemorrhagic stroke was 71.4%, 81.3%, 79.7% and 73.5% respectively. Overall accuracy for haemorrhagic stroke was found to be 76.3%. SSS had higher sensitivity for haemorrhagic stroke and is more sensitive in Asian population, but still not accurate enough to replace CT scan as investigation of choice but can plays a role to avoid delay in the management where CT scan is delayed or not available. 2015, TIP ARASTIRMALARI DERNEGI. All rights reserved.Item Prevalence of unrecognized depression in patients admitted in medical and surgical departments of a tertiary care hospital: a comparative analysis, Karachi, Pakistan(2015-04-06) Rahman, Attiya Sabeen; Aziz, Adnan; Jamal, Qaiser; Siddiqui, Muhammad A.Objective The aim of this study was to assess the frequency of depression in medical and surgical department using PHQ-9 questionnaire and to compare the incidence of depression in acute and chronic medical and surgical patients. Material and Methods This cross-sectional comparative analysis was conducted from April 2013 to March 2014. All patients admitted in the medicine and surgical departments were enrolled in the study. Patients with known history of depression or any other psychiatric history or on anti-depressants or on anti-psychotics were excluded from the study. Patients presenting with self-poisoning or any other suicidal attempt were also excluded from the study. Two residents from each department were trained to interview the patients according to the PHQ-9 questionnaire. The prevalence of depression was then seen in surgical and medical patients. Depression and its severity was seen and compared between the acute and chronic disorders of surgical and medical patients. Depression was also seen in between both genders in medical and surgical patients. Statistical analysis was performed using SPSS (IBM SPSS Statistics 20.0). Results A total of 748 patients were enrolled in which 399 patients and 349 patients were enrolled from the medicine and surgery department respectively. The mean age was 46.14 + 15 years of medical patients and 40.23 + 15 years of surgical patients. Among the 399 medical patients 233 (58.4%) were males, 349 surgical patients 178 (58%) were males. Gender was not found to be significantly associated with depression in medical (p= 0.367) and in surgical patients (p=0.606). Minimal depression was found in 48 (12%) medical patients and 131 (37.5%) surgical patients. Moderately severe and severe depression was found in 33 (8.3%) and 37 (9.3%) in medical patients respectively. While in surgical patients moderately severe depression was seen in 42 (12%) and severe depression was seen in 9 (2.6%) patients. Depression was significantly associated with acute and chronic medical disorders with a p<0.001.Depression was not significantly associated with acute and chronic surgical disorders with a p=0.059. Conclusion Unrecognized depression is a major health burden in Pakistan, and depression was significantly associated with acute and chronic medical disorders.Item Recognition of Core Elements of Medical Professionalism among Medical Students and Faculty Members(Oman Medical Specialty Board, 2016-05) Jahan, Firdous; Siddiqui, Muhammad A.; Al Zadjali, Najjat Mohammed; Qasim, RizwanObjectives: Medical students and future physicians have chosen to pursue a profession that requires personal integrity, compassion and a constant awareness of the commitment made by them. Professionalism includes personal behaviors, knowledge, and competency. It includes the attitudes and values one holds and that run through the profession as a whole. Medical students learn professionalism during the course by either direct teaching or experiential learning. We conducted this study to estimate the self-reported level of practice of the core elements of professionalism by medical students and medical faculty and compared the two groups. Methods: One-hundred and nine students and 83 faculty members of Oman Medical College completed a professionalism questionnaire. The survey questions related to core elements of professionalism and were grouped under professional knowledge, professional skills, professional attitude, and qualities essential for professionalism. Results: The response rate was 65.6% (109 of 166) among students and 75.5% (83 of 110) from faculty members. Response to the questions on professional skills between the student and faculty group was significantly different (p < 0.001). Similarly, there was a significant difference in the responses related to professional attitude between the student and faculty group (p < 0.001). Students and faculty members have a significant difference in opinion regarding up to date knowledge of basic and clinical sciences and clinical competency (p = 0.024). Similarly, significant differences in opinion regarding up to date knowledge of basic and clinical sciences and clinical competency in clinical and basic sciences faculty members (p = 0.001). Students identified good communication skills (82.6%), and faculty staff identified up to date professional knowledge (62.7%) as the most important aspect of professionalism. Conclusions: Both students and teaching faculty agreed that the top most professional elements are up to date knowledge, good communication skills, and teamwork. Hence, it is important that faculty members encourage their students to improve their professional skills and attitude. 2016, Oman Medical Specialty Board. All rights reserved.Item Obesity and insulin resistance: Management in diabetes(2013-09) Ashraff, Suhel; Siddiqui, Muhammad A.; Carline, TomObesity today, is a major public health problem across the world. The rapid increase in the incidence of obesity and associated co-morbidities presents a major challenge to health care globally. Insulin resistance is commonly associated with obesity and other life style diseases. However, much uncertainty remains about the mechanism regarding the association between insulin resistance and human disease mainly because of the difficulties of defining insulin resistance in clinical terms and of quantifying insulin action in humans. This review looks at the available literature concerning the link between obesity and insulin resistance and discusses the various approaches of their management.Item Effect of progressive resistive exercise training in improving mobility and functional ability of middle adulthood patients with chronic kidney disease(Wolters Kluwer, 2015) Sah, Sanjiv K.; Siddiqui, Muhammad A.; Darain, HaiderPatients with chronic kidney disease (CKD) in their middle adulthood are more prone to reduced mobility than younger patients having the same medical condition. Progressive resistive exercise training (PRT) is deemed an effective treatment approach for the management of muscular weakness in patients with CKD. The present review is an attempt to understand the effectiveness of PRT in the mobility and functional ability of patients suffering from CKD. We systematically searched electronic databases, including Medline, Scopus, PubMed, CINAHL, PEDRo and Cochrane, to review the published literature on this subject. Electronic searches were limited to training programs carried out on resistive, aerobic, endurance and therapeutic exercises reporting outcome measures including muscular strength, size, physical function and functional capacity in the clinical population with CKD aged > 40 years. Studies with a minimum duration of eight weeks of exercise training or more were considered eligible for review. The methodological criteria of the included studies were assessed with the PEDro scale. A total of 80 articles were identified using the keywords in the above-mentioned databases. However, based on the study's inclusion and exclusion criteria, only 11 articles were finally included. The results of this review substantiate the effectiveness of PRT in patients with CKD. However, further research is warranted in this area due to the limited availability of high-quality published evidence.Item Measurement of changes in the oxygenation of quadriceps muscles during the voluntary and involuntary fatigue test in normal healthy sedentary subjects(Universidad de Alicante, 2015) Rehma, Amir Ur; Siddiqui, Muhammad A.; Darain, HaiderThe Purpose of this study is to investigate the changes in muscle oxygen consumption in response to the different fatigue protocol cycle ergometry and electrical stimulation (voluntary and involuntary) in human quadriceps muscle using near infrared spectroscopy (NIRS). Fifteen healthy sedentary voluntary University students between ages 20-60 were invited to participate in the study. Three minutes stimulation was performed to fatigue the muscle. Changes in muscle oxygenation were measured by near infrared spectroscopy. The present resistance was calculated as the estimated maximal power output. The data were analysed using the Kolmogorov-Smirnov (K-S) test to determine the distribution. Descriptive statistics are used to characterize the shape, central tendency, and variability within a set of data. Differences were tested by utilizing the Friedman test the level of statistical significance was set at P<0.05. There was no significant difference (p>0.05) was found between right leg oxygenated (HbO2), deoxygenated (HHb), and total haemoglobin (CHb) as compared to left leg during cycle ergometry fatigue test. On the other hand, significant difference (p<0.05) was found in oxygenated haemoglobin of right leg when two (cycle ergometry and electrical stimulation) fatigue results were compared. However, no significant difference (p>0.05) was found in deoxygenated (HHb) and total haemoglobin (CHb) of right leg when two (cycle ergometry and electrical stimulation) fatigue results were compared. There was no significant difference (p>0.05) found in oxygenated, deoxygenated and total haemoglobin between right and left leg cycle ergometry fatigue indices. Similarly, no significant difference (p>0.05) was found in oxygenated, deoxygenated and total haemoglobin of right leg when two (cycle ergometry and electrical stimulation) fatigue indices were compared. The significant difference (p<0.001) were found between two (cycle ergometry and electrical stimulation) fatigue results. This study reveals that the oxygen consumption was more in the electrical stimulation as compared to the cycle ergometry during the fatigue test. Significant difference was observed between the oxygenated haemoglobin when comparing the electrical stimulation with cycle ergometry. Similarly, significant differences were found between the legs in cycle ergometry fatigue test. influences, together with exercise-induced-effects, should be considered as causes. Results show a functioning preparation-system within the DRV for better prepared-junior-athletes to commence the IPCP. Faculty of Education. University of Alicante.Item Development of prognostic model for fistula maturation in patients with advanced renal failure(BioMed Central, 2018-03-07) Siddiqui, Muhammad A.; Ashraff, Suhel; Santos, Derek; Rush, Robert; Carline, Tom; Raza, ZahidBackground: This study aimed to explore the role of patient's characteristic and haematological factors as predictive on the maturation of arteriovenous fistulae in patients who underwent vascular access surgery at the Royal Infirmary of Edinburgh. Methods: Retrospective data from 300 patients who had undergone fistula creation between February 2007 and October 2010 was examined. A predictive logistic regression model was developed using the backward stepwise procedure. Model performance, discrimination and calibration, was assessed using the receiver operating characteristics (ROC) curve and Hosmer and Lemeshow goodness of fit test. Results: Three variables were identified which independently influenced fistula maturation. Males were twice as likely to undergo fistula maturation, compared to that of females (odds ratio (OR) 0.514; 95% confidence interval (CI) 0.308-0.857), patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula (OR 3.140; 95% CI 1.596-6.177) and a pre-operative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation compared to a vein size less than 2.5 mm (OR 4.532; 95% CI 2.063-9.958). The model for fistula maturation had fair discrimination as indicated by the area under the ROC curve (0.68; 95% CI 0.615-0. 738) but good calibration indicated by Hosmer and Lemeshow test (p = 0.79). Conclusion: Gender, PVD and vein size are independent predictors of arteriovenous fistula maturation. The clinical utility of these risk equation in the maturation of arteriovenous fistulae requires further validation in the newly treated patients.
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